Our Health Library

Chiropractic and Immunity.

Studies on Effects of Spinal Manipulation on the Immune Response Stephen H. Injeyan, DC, PhD This work is in progress under a grant from the Consortial Center for Chiropractic Research and the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM)

The immune and endocrine systems are integrated through mutual communication mediated by endogenous mediators such as cytokines and neuroendocrine peptides. Scientific evidence also shows that activation of the autonomic nerve system may lead to alteration in various physiological responses including the immune and inflammatory responses.

Published evidence in the chiropractic literature suggests that spinal manipulative treatment (SMT) may affect the immune system. In the present study, the effect(s) of a single SMT on various aspects of the immune response is being investigated. To: 1) determine whether a single chiropractic treatment induces alterations in the T-cell-mediated humoral (B cell) response, 2) establish if spinal manipulation affects the production of soluble mediators (cytokines) of the immune and inflammatory responses.

Changes in Health Measures in HIV+ Chiropractic Patients Lisa A. Caputo, DC This work is in progress under a grant from the Consortial Center for Chiropractic Research and the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM)

The long-term objectives of this research are to examine the effects of chiropractic care on health-related quality of life (HRQoL) in people living with HIV/AIDS (PLA). The specific aims of this study are:

To determine the profile of a population of HIV+ patients in a hospital-based chiropractic clinic with respect to clinical staging and response profiles to the Medical Outcome Study-HIV Health Survey (MOS-HIV), Oswestry Disability Questionnaire (ODQ) and/or Neck Disability Index (NDI) and Numeric Rating Scale-11 (NRS-11); and

To determine if there is a change in self-reported HRQoL, levels of pain and perceived disability in PLA receiving chiropractic care.

Effect of Vertebral Loading on Sympathetic Nerve Regulation Joel G. Pickar, DC, PhD This work is in progress (See it at the bottom of the page) under a grant from the Consortial Center for Chiropractic Research and the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM)

The nerve system plays a pivotal role in chiropractic theory and practice. The concepts forming the cornerstones of chiropractic, namely the "subluxation" and the "adjustment" have continually emphasized this point. Chiropractic has long held that subluxations can produce disorders of internal organs and spinal manipulation can ameliorate and/or alleviate these disorders via their effects on the nerve system.

The purpose of this project was to determine if sensory input from paraspinal tissues affects sympathetic nerve activity and thus could contribute directly to the function of an internal organ. The specific aims of this study were to determine if mechanical loading of a vertebra alters the magnitudes of, patterns of, or relationships between sympathetic nerve discharge to discrete organ systems.

Chiropractic RX for Chronic Otitis Media With Effusion David Eisenberg, MD This work is in progress under a grant from the Consortial Center for Chiropractic Research and the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM)

The aim of the proposal is to examine whether chiropractic treatment will reduce the likelihood of the persistence of effusion in children with otitis media with effusion (OME) when compared to usual care.

The innervation of the tensor veli palatini (tvp) muscle is through the motor fibers of the mandibular branch of the trigeminal nerve. These fibers unite to form portions of the superior cervical ganglion located between the C-1 and C-4 nerve roots. Neurological compromise of this muscle by osseous or soft tissue structures may contribute to the malfunction of the tvp muscle causing inadequate patency of the tube resulting in the pathological response of OME. Chiropractic therapy may improve the function of the TVP.

There is no shortage of theories to explain the role of the subluxation in disease and the effect of the adjustment in relieving symptomatology. The autonomic nerve system has often been invoked in constructing mechanisms to account for the effects of spinal dysfunction. Recent investigations justify the attention which has been focused on this component of the nerve system.

Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nerve system, which in turn may alter visceral function.

This paper outlines the many components of the mammalian immune system and the anatomical and physiological connections suggesting that the nerve system plays a role in the modulation of immune response. The few studies attempting to measure the effect of chiropractic or manipulative treatment on the immune system are reviewed. Their results suggest that chiropractic or manipulative treatment may influence T and B lymphocyte numbers, NK cell numbers, antibody levels, phagocytic activity and plasma beta-endorphin levels. The influence of these effects on the outcome of host resistance is unknown. There is now a need for large, well-planned clinical trials using some of the more sophisticated measures of immune function to establish whether chiropractic treatment can influence the immune response in a clinically significant manner.

A critical need in assessing the clinical utility of manipulative therapy for back pain is the identification of biological changes associated with the forces applied by spinal manipulation. Such changes could then serve as markers for both sham treatment and manipulation. We determined the priming of polymorphonuclear neutrophils for an enhanced respiratory burst and its duration, the priming of mononuclear cells for enhanced endotoxin-stimulated tumor necrosis factor production and plasma levels of substance P following a single thoracic spine manipulation. There was a significant difference in the respiratory burst of polymorphonuclear neutrophils in response to a particulate challenge, depending on the time of blood sample collection.

The response of polymorphonuclear neutrophils isolated from blood collected 15 min after manipulation was significantly higher than the response of cells isolated from blood collected 15 min before and 30 and 45 min after manipulation. Mononuclear cells were also primed for enhanced endotoxin-stimulated tumor necrosis factor production by spinal manipulation. Both of these priming effects were accompanied by a slight, but significant elevation in plasma substance P. The mean manipulation force associated with these biological effects was 878 +/- 99 N. These biological effects may provide a means of monitoring the delivery of both sham and manipulative treatment and, therefore, provide a crucial tool for understanding the efficacy of manipulative therapy.

The effect of spinal manipulation on the respiratory burst of polymorphonuclear neutrophils (PMN) and monocytes from treated adults was measured by zymosan-stimulated chemiluminescence (CL). Peripheral blood was collected 15 min before and 15 min after treatment (sham manipulation, thoracic spine manipulation, or soft tissue manipulation), the cells were isolated, challenged with a standardized, opsonized luminol-containing suspension of zymosan, and monitored for CL. Plasma from two subsets of subjects was radioimmunoassayed for Substance P (SP). PMN were also preincubated with SP in vitro over the dose range 5 x 10(-12) M to 5 x 10(-8) M and the CL responsemonitored.

The CL responses of both PMN and monocytes from subjects who received spinal manipulation were significantly higher after than before treatment, and significantly higher than the response in sham or soft-tissue treated subjects. Measurement of the force applied by sham and spinal manipulation suggested a force threshold for the enhancement of the CL response. Plasma levels of SP before and after treatment in sham treated subjects did not differ significantly; however, elevated plasma SP was observed in subjects after spinal manipulation. Preincubation of PMN with 1 x 10(-11) M, 5 x 10(-11) M or 1 x 10(-10) M SP in vitro primed PMN for an enhanced respiratory burst when the cells were subsequently challenged.

There is an increasing body of evidence that the nerve system is capable of modulating the immune response. Receptors for neuromodulators and neurohormones have been found on human T lymphocytes. Activation of these receptors can be stimulatory or inhibitory depending on the neuroactive substance. The immune system may be able to communicate with the nerve system using neuromodulators and neurohormones secreted by lymphocytes. Sympathetic innervation of lymphoid tissues is not restricted to blood vessels and smooth muscle, but directly supplies lymphocytes and blood precursor cells. It is theorized that spinal fixations may adversely affect the immune response through somatosympathetic reflexes. Spinal manipulation can correct the spinal fixations and may eliminate the adverse affects of somatosympathetic reflexes.